Affordable Care Act Implementation Continues

A significant date in the implementation of the federal Patient Protections and Affordable Care Act (PPACA) is approaching. Starting on October 1, 2013, health insurance “exchanges” will be implemented in states all across the country. Because Governor Perry opted out of forming a state-run exchange, the federal Department of Health and Human Services (DHHS) will run the Texas version.

What is a health insurance exchange? It is essentially an online marketplace where individuals and small employers will be able to shop for health insurance. Insurers will provide plans to the exchange based on set criteria, and those seeking insurance will go to a website to choose a plan and find out whether they are eligible for federal subsidies to help cover the cost of coverage.

Most Texas cities either provide coverage for their employees or are too small to be mandated to do so. That means the implementation of the exchange likely won’t directly affect most cities.

However, as elected and appointed community leaders, city officials may receive general questions from their constituents about how the exchange will function. The National League of Cities (NLC) is coordinating with DHHS to disseminate information relating to the exchanges. To that end, Texas city officials may need to know how an individual constituent goes about seeking coverage through the exchange.

An individual (or small business) can visit healthcare.gov to learn more. After answering a few questions, the site will provide options and directions on how to proceed. Once the Texas exchange is open on October 1, 2013, individuals will take the following steps:

1. Create an account. The first step is to create an account. Individuals will need to provide some basic information, including name, address, age, number of family members, choose a user name and password, and provide answers to a series of security questions.

2. Apply for insurance. Starting October 1, 2013, every individual or household that does not have insurance and has created an account will be asked to provide information that will enable the Healthcare Marketplace to determine which coverage is most appropriate, and how much it will cost.

Those who want insurance will have to provide information about income, information on their children and other dependents, information about their employer, and proof that they are an American citizen or in the United States legally.

Income is perhaps the most important information, because it will determine how large or small of a federal insurance subsidy that an individual or their household will receive, and therefore, how much the insurance coverage will cost the individual or family. The PPACA has very clear guidelines about the percentage of income individuals will be required to pay for insurance, and anything above that amount is likely to be paid through a federal subsidy.

3. Review the options and pick a plan. The third step in this process will be for residents to review their available insurance options, compare benefits and cost, including co-pays and drug benefit plans, and select the plan that is most appropriate for them or their household. The Healthcare Marketplace will allow everyone who uses its services to do side-by-side comparisons of health care plans.

4. Sign up. The last step will be to actually sign up for the insurance plan of choice. Once this is done, individuals and households will have insurance. Everyone who signs up for insurance between October 1, and December 31, 2013, will be insured as of January 1, 2014. Those who enroll between January 1, and March 31, 2014 will have insurance starting in the month after which they signed up.

DHHS has provided the following facts to the League to be disseminated:

The first thing you should know about the Affordable Care Act is it’s already working for millions of Americans. The 85 percent of Americans who already have health insurance are now getting better value for their dollar, have access to preventive care with no copays, and are saving money on prescription drugs in the Medicare Part D donut hole.

The second thing to know is that for the 15 percent of Americans who don’t have coverage, or for Americans who buy their own insurance right now and aren’t happy with it, they’ll have better options come this fall.

There is now a very simple way to get health insurance. Insurance that will fit your needs, your lifestyle, and your budget at any income level.

Starting October 1, 2013, the new healthcare law will allow you to purchase health insurance through a new online marketplace.

You will be able to shop among affordable choices, explained in easy-to-understand language.

In many states, premiums are dropping, often substantially. And for people with the lowest income levels, coverage will be completely free. For other incomes, discounts may apply.

Getting affordable health coverage means you’re covered when you need it. As you build your life on your terms, you can rest easy knowing that your finances won’t be turned upside down by health care costs from an illness or accident.

The new online marketplace opens October 1. Visit www.healthcare.gov and find your state’s online marketplace. See all your health insurance options – including the new discounted plan that fits your needs. All in one place, all explained simply

In addition, President Obama and DHHS Services Secretary Kathleen Sebelius will conduct a conference call with state and local elected officials on Wednesday, September 25, 2013, at 1:30 p.m. central time to discuss the launch of the exchanges. To participate, city officials must RSVP at www.att-rsvp.com with conference number 303712 to receive the call-in information. (Note: According to DHHS, the call is “off the record and not for press purposes.”)

TML member cities may use the material herein for any purpose. No other person or entity may reproduce, duplicate, or distribute any part of this document without the written authorization of the Texas Municipal League.